Document Detail


Clinical mapping approach to diagnose electrical rotors and focal impulse sources for human atrial fibrillation.
MedLine Citation:
PMID:  22537106     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The perpetuating mechanisms for human atrial fibrillation (AF) remain undefined. Localized rotors and focal beat sources may sustain AF in elegant animal models, but there has been no direct evidence for localized sources in human AF using traditional methods. We developed a clinical computational mapping approach, guided by human atrial tissue physiology, to reveal sources of human AF.
METHODS AND RESULTS: In 49 AF patients referred for ablation (62 ± 9 years; 30 persistent), we defined repolarization dynamics using monophasic action potentials (MAPs) and recorded AF activation from 64-pole basket catheters in left atrium and, in n = 20 patients, in both atria. Careful positioning of basket catheters was required for optimal mapping. AF electrograms at 64-128 electrodes were combined with repolarization and conduction dynamics to construct spatiotemporal AF maps. We observed sustained sources in 47/49 patients, in the form of electrical rotors (n = 57) and focal beats (n = 11) that controlled local atrial activation with peripheral wavebreak (fibrillatory conduction). Patients with persistent AF had more sources than those with paroxysmal AF (2.1 ± 1.0 vs 1.5 ± 0.8, P = 0.02), related to shorter cycle length (163 ± 19 milliseconds vs 187 ± 25 milliseconds, P < 0.001). Approximately one-quarter of sources lay in the right atrium.
CONCLUSIONS: Physiologically guided computational mapping revealed sustained electrical rotors and repetitive focal beats during human AF for the first time. These localized sources were present in 96% of AF patients, and controlled AF activity. These results provide novel mechanistic insights into human AF and lay the foundation for mechanistically tailored approaches to AF ablation.
Authors:
Sanjiv M Narayan; David E Krummen; Wouter-Jan Rappel
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-04-26
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  23     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-08     Completed Date:  2012-09-04     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  447-54     Citation Subset:  IM    
Copyright Information:
© 2012 Wiley Periodicals, Inc.
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MeSH Terms
Descriptor/Qualifier:
Action Potentials
Adult
Aged
Aged, 80 and over
Atrial Fibrillation / diagnosis*,  etiology,  physiopathology,  surgery
Atrial Function*
California
Cardiac Catheterization
Catheter Ablation
Chi-Square Distribution
Electrophysiologic Techniques, Cardiac*
Female
Heart Conduction System / physiopathology*,  surgery
Humans
Male
Middle Aged
Predictive Value of Tests
Signal Processing, Computer-Assisted
Time Factors
Grant Support
ID/Acronym/Agency:
HL70529/HL/NHLBI NIH HHS; HL83359/HL/NHLBI NIH HHS; HL83359-S1/HL/NHLBI NIH HHS; K23 HL070529/HL/NHLBI NIH HHS; K23 HL070529-01/HL/NHLBI NIH HHS; K23 HL070529-02/HL/NHLBI NIH HHS; K23 HL070529-03/HL/NHLBI NIH HHS; K23 HL070529-04/HL/NHLBI NIH HHS; K23 HL070529-05/HL/NHLBI NIH HHS; K24 HL103800/HL/NHLBI NIH HHS; R01 HL083359/HL/NHLBI NIH HHS; R01 HL083359-01A1/HL/NHLBI NIH HHS; R01 HL083359-02/HL/NHLBI NIH HHS
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